Authors' objectives: This report has been produced in response to a request from Alberta Health an Wellness for an update on the use of vagus nerve stimulation (VNS) for refractory epilepsy. The first section summarizes the findings of the current review of the published literature that has provided evidence on the long-term safety and efficacy/effectiveness of VNS when used for this indication and on the issues related to its use.The second section presents updated information on the use and coverage of VNS procedure in Canada.

Authors' recommendations: The reviewed literature suggests that VNS therapy is safe, well tolerated and effective when used as adjunctive therapy in patients (12 years of age) with partial-onset seizures refractory to medication, who are not candidates for epilepsy surgery or failed surgery. Since the previous review, limited follow-up evidence reported by uncontrolled studies suggest a continuous decrease in seizure frequency with long-term use of VNS therapy. It appears that its benefits and safety do not diminish over time for those who continue to use it. However, questions remain on the mode of action of VNS, which patients are likely to respond, the effect of VNS in less severely afflicted patients, the effect of VNS in different syndromes of epilepsy, and QOL of treated patients and their caregivers. Further research is needed on these aspects and on the details of stimulation paradigms such as different stimulation protocols (rapid cycle, early activation, duration of on/off cycles) and use of VNS in different syndromes of epilepsy. Patients considering VNS therapy and their caregivers should be aware that: - VNS therapy appears to have a moderate initial efficacy that may increase over time but it is not a cure for epilepsy. - VNS should only be used as a last resort after an extensive and thorough patient evaluation to rule out non-epileptic conditions and exclude patients who may benefit from available AED therapy and epilepsy surgery. - VNS does not work for everyone. - The safety and efficacy of VNS in children with refractory epilepsy has yet to be established. - VNS appears to have a favorable safety profile when compared to conventional therapies but the possibility of unknown adverse effects associated with its use still exists. The use and coverage of VNS in Canada: Interest in and provision of VNS therapy has increased across Canada. 11 of the 12 Ministries of Health responding to the survey cover this procedure and the device through their medical insurance programs, and hospital budgets. VNS is available in seven provinces, while three provinces and one territory provide coverage for the procedure to be done in another province.

Authors' methods: Review, survey

Project Status: Completed

Year Published: 2001

URL for published report: http://www.ihe.ca/advanced-search/vagus-nerve-stimulation-for-refractory-epilepsy

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>